Most of the extra $933 billion Americans spent on health care in 2013 versus 1996 is due to higher charges for care and patients getting more intense, expensive care.

Population growth and aging was the next biggest driver of the spending increase, according to a new analysis published in JAMA. Change in the prevalence of disease was associated with a slight decrease in annual spending, and change in how frequently health care services were used appeared to have no effect.

“We have known for many years that’s it’s prices that are responsible for our high level of spending,” said Gerard Anderson of the Bloomberg School of Public Health at Johns Hopkins who was not involved in the new research. He published a paper with colleagues in 2003 entitled “It’s The Prices, Stupid.”

Though the big-picture finding is not surprising, the main value in the new analysis is its breakdown of spending by disease, Anderson says.

“When you look at the different diseases, you find that you have different factors that lead to the major increase,” said Joseph Dieleman of the University of Washington’s Institute for Health Metrics and Evaluation and lead author of the study.

For example, diabetes was the disease with the greatest increase in yearly spending during the study period: $64 billion. Most of that, $44 billion, was due to spending on pharmaceuticals. Every factor the researchers looked at made some contribution to the increase, Dieleman said: U.S. population growth, aging, the prevalence of diabetes, utilization of pharmaceuticals and their price.

But for low back and neck pain, at $57 billion the runner up for greatest increase in spending, the factors were different. The prevalence didn’t change, but the amount of care people got for their low back and neck pain went up, adding up to a 8.5% increase in spending for inpatient care per year.

Yearly spending on inpatient care for all diseases increased $258 billion to $697 billion, despite efforts to reduce utilization that amounted to a $201 billion spending decrease. People did have shorter hospital stays, but all the care they would have received just got packed into fewer days, and spending still went up.

“The amount of spending in one day has gone through the roof,” Dieleman said. “Our best intentions to reduce spending hasn’t had as big of an impact as people wanted.”

The analysis shows that a popular justification for high drug prices, that savings come out elsewhere like in preventing hospitalizations, doesn’t have convincing evidence in the big picture of health care spending, says Peter Bach, director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center. “We are not getting offsets, period.”

For all the granularity of breaking spending down by disease, Joseph Newhouse, director of the Division of Health Policy Research and Education at Harvard, points out that the paper says nothing about the value purchased with the spending. The cost may have been worth it, but it’s hard to say.

“It’s fine to have this cost broken down, but I don’t really know what to do with it,” Newhouse said. “It’s like having one blade of a scissors.”

Dieleman sees the data set the paper is based on as enabling future research on the value of healthcare spending. “This essentially allows people to start asking those questions.”